Provider Demographics
NPI:1093912685
Name:SPECIAL NEEDS PROGRAM, INC
Entity Type:Organization
Organization Name:SPECIAL NEEDS PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MEROL
Authorized Official - Last Name:HIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-822-1054
Mailing Address - Street 1:1351 ROUTE 66
Mailing Address - Street 2:P.O. BOX 349
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075
Mailing Address - Country:US
Mailing Address - Phone:518-822-1054
Mailing Address - Fax:518-822-0739
Practice Address - Street 1:1351 ROUTE 66
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075
Practice Address - Country:US
Practice Address - Phone:518-822-1054
Practice Address - Fax:518-822-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02250008Medicaid
NY02648286Medicaid
NY02003249Medicaid
NY02597597Medicaid
NY02701320Medicaid
NY02587364Medicaid
NY00979800Medicaid
NY02111080Medicaid
NY01825992Medicaid
NY02363495Medicaid
NY02587373Medicaid